Making matters worse, survivors say America’s continuing string of mass shootings has further haunted their lives.

Workers’ compensation attorney Geraldine Ly said about 80 percent of her dozen clients who filed claims in the San Bernardino mass shooting “have sought or will be seeking” to take medical retirement.

“They attempted to go back to work, but psychologically they just couldn’t do it,” Ly said. “The memories of their deceased friends are with them 8 to 10 hours a day” as they try to do their job, she said.

All but one of the 14 who died in the Dec. 2, 2015, attack worked for San Bernardino County’s Environmental Health Services Division. Many of their colleagues in the room, including those not struck by bullets, suffered post-traumatic stress disorder. Authorities put the number of survivors at 57.

They had gathered at the Inland Regional Center in San Bernardino for a training event and holiday party when co-worker Syed Rizwan Farook, 28, a health inspector, and Tashfeen Malik, his Pakistani-born wife, began shooting.

Two people who were involved in a shooting inside the Inland Regional Center in San Bernardino share a moment after being evacuated to San Bernardino Golf Club, located across the street from the Inland Regional Center, on Wednesday, Dec. 1, 2015. (File photo by David Bauman, The Press-Enterprise/SCNG)

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A victim is transported from the Inland Regional Center building in San Bernardino after a mass shooting took place on Wednesday, Dec. 2, 2015. (File photo by David Bauman, The Press-Enterprise/SCNG)

A victim of the San Bernardino mass shooting is transported to a waiting ambulance as other ambulances stand ready at the scene of the shooting at the Inland Regional Center in San Bernardino Wednesday, Dec. 2, 2015. (File photo by David Bauman, The Press-Enterprise/SCNG)

Emergency personnel gather outside the Inland Regional Center in San Bernardino after a mass shooting there on Wednesday, Dec. 2, 2015. (File photo by David Bauman, The Press-Enterprise/SCNG)

A police officer checks a vehicle coming to the emergency entrance of Arrowhead Regional Medical Center in Colton after a mass shooting in San Bernardino on Wednesday, Dec. 2, 2015. (File photo by Kurt Miller, The Press-Enterprise/SCNG)

A SWAT vehicle carries police officers north on Waterman Avenue where an active shooter situation was taking place at the Inland Regional Center on Wednesday, December 2, 2015, San Bernardino. (File photo by Micah Escamilla, The Sun/SCNG)

An armored vehicle makes it way down Almond and Mt. View in San Bernardino after two suspects were shot after a mass shooting at the Inland Regional Center on Wednesday, Dec. 2, 2015. (File photo by Kurt Miller, The Press-Enterprise/SCNG)

SWAT members are transported on an armored vehicle at the scene after a mass shooting in San Bernardino Wednesday, Dec. 2, 2015. (File photo by David Bauman, The Press-Enterprise/SCNG)

Law enforcement officers search for a suspect involved where at least 14 people were killed and 14 others injured at an incident at the Inland Regional Center on Wednesday December 2, 2015. (File photo by Keith Durflinger, Los Angeles Daily News/SCNG)

A San Bernardino County Sheriff’s officer trains his weapon at an area where a shooting suspect or suspects is thought to be hiding along San Bernardino Ave in the city of Redlands. (File photo by Ed Crisostomo, The Press-Enterprise/SCNG)

SWAT officers in an armored vehicle make their way down the 1500 block of South Richardson in San Bernardino to investigate a report of a possible shooting suspect hiding in the area after a mass shooting in San Bernardino on Wednesday, Dec. 2, 2015. (File photo by David Bauman, The Press-Enterprise/SCNG)

SWAT officers from the San Bernardino County Sheriff’s Department stage in the 1500 block of South Richardson in San Bernardino as they respond to a report of a possible shooting suspect hiding in the area after a mass shooting in San Bernardino on Wednesday, Dec. 2, 2015. (File photo by David Bauman, The Press-Enterprise/SCNG)

SWAT officers point their weapons down a road located on the north side of Victoria Elementary School in the 1500 block of South Richardson in San Bernardino following a report of a possible shooting suspect in the area, on Wednesday, Dec. 2, 2015. (File photo by David Bauman, The Press-Enterprise/SCNG)

Police respond to the scene of an active shooting at Inland Regional Center in San Bernardino, CA on Wednesday, Dec. 2, 2015. Officials say 15 to 20 people have been wounded. (Photo by Rachel Luna/The Sun)

SWAT officers approach a building n the 1500 block of South Richardson in San Bernardino to investigate a report of a possible shooting suspect in the area, on Wednesday, Dec. 2, 2015. (File photo by David Bauman, The Press-Enterprise/SCNG)

SWAT officers run to the north side of Victoria Elementary School in the 1500 block of South Richardson in San Bernardino following a report of a possible shooting suspect in the area, on Wednesday, Dec. 2, 2015. (File photo by David Bauman, The Press-Enterprise/SCNG)

A Redlands Police officer moves into position as police search for gunmen at Richardson and San Bernardino Avenue after a mass shooting that left 14 people dead in San Bernardino Wednesday, Dec. 2, 2015. (File photo by David Bauman, The Press-Enterprise/SCNG)

Law enforcement personnel run with guns drawn toward an officer involved shooting in San Bernardino after a mas shooting earlier in the day at the Inland Regional Center in San Bernardino on Wednesday, Dec. 2, 2015. (File photo by David Danelski, The Press-Enterprise/SCNG)

Law enforcement personnel from various agencies run with guns drawn toward an ongoing officer involved shootout in San Bernardino after a mass shooting earlier in the day at the Inland Regional Center in San Bernardino on Wednesday, Dec. 2, 2015. (File photo by David Danelski, The Press-Enterprise/SCNG)

Police respond to the scene of a police shootout in San Bernardino, CA on Wednesday, Dec. 2, 2015. Officials reported upwards of 14 people killed and 14 people wounded. (Photo by Rachel Luna/The Sun)

Emotions are high as workers are reunited on Waterman Avenue south of Orangeshow Blvd. after gunmen killed 14 people and injured many more during a mass shooting in San Bernardino Wednesday, Dec. 2, 2015. (File photo by Terry Pierson, The Press-Enterprise/SCNG)

Officers search San Bernardino Ave. for evidence on Thursday, Dec. 3, 2015 near the SUV that the shooting suspects were driving, a day after a mass shooting in San Bernardino. (File photo by Kurt Miller, The Press-Enterprise/SCNG)

Law enforcement officers search for a suspect involved where at least 14 people were killed and 14 others injured at an incident at the Inland Regional Center on Wednesday December 2, 2015. (File photo by Keith Durflinger, Los Angeles Daily News/SCNG)

People gather at San Bernardino Golf Course after being evacuated from Inland Regional Center where an active shooter situation had taken place on Wednesday, December 2, 2015, San Bernardino. (Micah Escamilla, The Sun/SCNG)

Emilie Gleisberg, left, hugs her mother Diane Kimble, right, as family members reunite at The Rock Church after at least 14 people were killed and 17 others injured by two shooters at the Inland Regional Center in San Bernardino on Wednesday, Dec. 2, 2015. (Thomas R. Cordova, Daily Breeze/Press-Telegram/SCNG)

Law enforcement officers search for a suspect involved where at least 14 people were killed and 14 others injured at an incident at the Inland Regional Center on Wednesday December 2, 2015. (Photo by Keith Durflinger/Los Angeles News Group)

SWAT team at the scene after the shootout between San Bernardino Police and the suspects near the intersection of Richardson St. and San Bernardino Ave. in San Bernardino, Calif. on Wednesday, Dec. 2, 2015. Two suspects were believed killed or wounded, and a third possibly remained on the loose, following an exchange of gunfire near the scene of a mass shooting at the Inland Regional Center in San Bernardino.(Photo by Watchara Phomicinda/ Los Angeles News Group)

Staff from the Inland Valley Regional Facility for the Mentally Disable walk to school buses on Waterman Avenue after shooter, shot as many as 20 people at the Inland Valley Regional Facility in San Bernardino, CA., Wednesday, December 2, 2015. (Photo by James Carbone for the SAn Bernardino Sun)

In this image taken from video, armored vehicles surround an SUV following a shootout in San Bernardino, Calif., Wednesday, Dec. 2, 2015. The scene followed a military-style attack that killed multiple people and wounded others at a California center that serves people with developmental disabilities, authorities said. (KTTV via AP)

Authorities in San Bernardino have responded to an active shooter situation near the Inland Regional Center where city fire officials say 15 to 20 people have been wounded. (Photo by KTLA)

Emotions are high as workers are reunited on Waterman Avenue south of Orangeshow Blvd. after gunmen killed 14 people and injured others during a mass shooting in San Bernardino Wednesday, Dec. 2, 2015. (File photo by Terry Pierson, The Press-Enterprise/SCNG)

Police officers investigate the site of a shootout along E. San Bernardino Ave., in San Bernardino on Thursday, Dec. 3, 2015 the day after two attackers opened fire on a banquet at the Inland Regional Center in San Bernardino. (File photo by Ed Crisostomo, The Press-Enterprise/SCNG)

Police officers investigate the site of a shootout along E. San Bernardino Ave., in San Bernardino on Thursday, Dec. 3, 2015 the day after two attackers opened fire on a banquet at the Inland Regional Center in San Bernardino. (File photo by Ed Crisostomo, The Press-Enterprise/SCNG)

Gordon and Denise Baciorek of Temecula show their support during a candle light vigil for the victims of a mass shooting at the Inland Regional Center held at San Manuel Stadium in San Bernardino on Thursday, Dec. 3, 2015. Police officers investigate the site of a shootout along E. San Bernardino Ave., in San Bernardino on Thursday, Dec. 3, 2015 the day after two attackers opened fire on a banquet at the Inland Regional Center in San Bernardino. (File photo by Terry Pierson, The Press-Enterprise/SCNG)

Alex Hernandez, of West Covina, lights a candle as he says a prayer along S Waterman Ave. on Friday, Dec. 4, 2015, near the Inland Regional Center, the site of a mass shooting in San Bernardino. (File photo by Ed Crisostomo, The Press-Enterprise/SCNG)

Melissa Smith of the Inland Emprire kneels in prayer at the make-shift memorial for the San Bernardino shooting victims at the corner of Waterman Ave. and Orange Show Rd. on Friday, Dec. 4, 2015. (File photo by Kurt Miller, The Press-Enterprise/SCNG)

A San Bernardino County Sheriff’s deputy escorts two young school girls to their home on San Bernardino Ave., on Friday, Dec. 4, 2015. The vehicle that two shooting suspects were shot to death by police in a few days earlier remains on the street. (File photo by David Bauman, The Press-Enterprise/SCNG)

Summer Adams, widow of Robert Adams, left, hugs her mother-in-law Carole Adams after Carole spoke to those attending the city of Yucaipa candlelight vigil held at Yucaipa Community Park in Yucaipa Sunday, Dec. 6, 2015 in the memory of Yucaipa resident Robert Adams, one of the 14 victims killed in the shooting in San Bernardino on Dec. 2. (File photo by Terry Pierson, The Press-Enterprise/SCNG)

The Inland Regional Center Conference Center still sits gated on Wednesday, May 25, 2016 in San Bernardino. The conference center was the site of the December 2 terrorist attack that occurred in San Bernardino.

The Inland Regional Center Conference Center still sits gated on Wednesday, May 25, 2016 in San Bernardino. The conference center was the site of the December 2 terrorist attack that occurred in San Bernardino.

A memorial site at the corner of Waterman Ave. and Orange Show Road, just north of the Inland Regional Center Conference Center still exists on Wednesday, May 25, 2016 in San Bernardino. The conference center was the site of the December 2 terrorist attack that occurred in San Bernardino.

People gather at the memorial site on the corner of Waterman Ave and Orange Show Rd for the shooting victims on Saturday, Dec.05, 2015 in San Bernardino.

Survivors complained in the two years after the attack that San Bernardino County’s workers compensation review system denied or delayed needed medicines, procedures, and psychological care. The county insists it “went far above and beyond the call of duty in streamlining the flow of compensation and benefits.”

“As each one happens, the other one is being forgotten. There was a shooting at a synagogue just before Thousand Oaks, and then by Thousand Oaks, the synagogue is forgotten. These are scores of people being murdered, and each one before is forgotten,” said Julie Swann-Paez, 53, who was wounded in the San Bernardino attack.

“There are some people now who don’t know about the Dec. 2 shooting, and it breaks my heart,” said Swann-Paez, who has taken medical retirement and moved last summer to Flagstaff, Arizona, with her husband and daughter.

In a telephone interview, she said more former colleagues left the county workforce after the Borderline shooting.

“One or two people who just decided they can’t do it. It’s just hard and the environment is not great for understanding” how a mass shooting can affect people who have been through one, she said.

‘He never showed his cards’

Ray Britain, 50, who was the county Environmental Health Services division’s interim chief at the time of the San Bernardino attack, still struggles to understand how a co-worker could do such a thing.

“It was one of our own employees,” he said in a telephone interview. “He didn’t show any signs or symptoms; it was not a disgruntled employee — he never showed his cards to us. That was a big betrayal that we never saw coming.”

Many also include “nervous system-not specified” and “nervous system-psychiatric/psych.”

Of the 20 cases found in a search of state workers’ compensation court electronic files with known survivor names linked to the attack, nine had reached some kind of settlement by late November.

Everyone who was in the room when the shooting started “has a major injury that will be with them for the rest of their lives,” said Britain of the PTSD. “What happened on Dec. 2 will change my life forever.”

‘Lost a whole division’

Of the 57 survivors, 42 had returned to work for the county at some point, San Bernardino County spokesman David Wert said in an email.

As of late November, 14 were working full time — one had transferred to a different county department — five were working part-time with doctor-required work restrictions, 19 were out on medical leave and 19 had left county employment.

Wert said it can’t be assumed that the attack is the reason for all of the job changes in the past three years.

Some of those who returned and are currently off work may be so for reasons other than the attack, he said. And others may have retired, taken jobs elsewhere or “separated from the county for reasons other than the attack.”

Britain, 50, who returned to work the day after the attack, said he lasted at work until about mid-January 2016. He is now medically retired. His personal estimate is that out of the 114 employees working in the Environmental Health Services Division at the time of the shooting, about 15 are still working full time. “They lost a whole division,” he said.

“When I look back … I was operating on emotion after the event. I had an expectation that, ‘this happened at work, and we would be taken care of,’ ” he said. “It became very apparent that help was not to be provided, and we would be on our own,” he said.

Looking for solutions

His application for psychological treatment under the county’s workers compensation program was initially denied, he said, but finally approved about a year later. Swann-Paez, who had part of her pelvis destroyed in the shooting, said a doctor’s request for a post-surgery home-care nurse late last year was initially denied, then approved — months after the need had passed.

Several of the survivors went public with accounts of their struggles and said the county should have stepped past the workers’ compensation utilization review system, in which contracted outside physicians decide whether an injured person’s doctor’s medical request is necessary.

Swann-Paez said part of her pelvis is gone, but the only classification for her wound under the workers’ compensation system was “fractured pelvis.”

“They could not think outside the box, they could not treat this as an extraordinary situation,” she said of the county’s self-funded system.

“The California Department of Industrial Relations investigated the workers’ comp issue in relation to the attack in 2016-2017, examined all documentation, and found delays and denials were extremely rare, were almost always upheld on appeal, and were attributable to failures by the survivors’ healthcare providers,” county spokesman Wert said in statement.

He said the county created “new processes and enhanced benefits for the survivors” that received awards from the National Association of Counties and the California State Association of Counties. “The county would have had no motive to unnecessarily delay or deny treatment. Doing so would not have saved the county any money, time or effort,” he wrote.

In 2017, Assemblywoman Eloise Reyes, D-Grand Terrace, introduced AB 44, a bill designed to allow workers or first responders hurt in a terrorist attack or workplace violence to bypass utilization review. The bill also would have extended benefits from two years to four and a half years.

The language was stripped from the bill, but Reyes said in a telephone interview she is not done trying to address the issues through legislation.

“The entire utility review process, we have known for years, is a problem for injured workers … and is something that needs to be addressed,” said Reyes, who was a workers’ compensation attorney before being elected.

The issues for the Dec. 2 attack survivors, she said, “brought out more acutely the failings of the system. … My team and I are looking into ways that we can address this legislatively, to find just ways of treating victims in future incidents,” she said.

A journalist since 1975 for City News Service in Los Angeles, The Associated Press in Los Angeles and New York, and The Press-Enterprise, Richard K. De Atley has been Entertainment Editor and a features writer. He has also reported on trials and breaking news. He is currently a business reporter for The P-E. De Atley is a Cal State Long Beach graduate, a lifelong Southern Californian (except for that time in New York -- which was great!) and has been in Riverside since 1992.